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NPI Code Detail

MEDICARE: KHADER MEDICAL PC

MEDICARE: KHADER MEDICAL PC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207RG0300XGeriatric Medicine (Internal Medicine) Physician002706NY

General Provider Information

NPI Number : 1821304916
Entity Type Code : Organization
Provider Name (Legal Business Name) : KHADER MEDICAL PC
Provider Business Mailing Address
First Line : 25 BANK ST
Second Line : APT 214 H
City : WHITE PLAINS
State : NY
Zip : 10606-7000
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1072 GRAND CONCOURSE
Second Line :
City : BRONX
State : NY
Zip : 10456-3901
Country : US
Telephone Number : 718-681-4000
Fax Number :
Authorized Official
Title or Position : OWNER
Name : RAWAND KHADER
Credential :
Telephone Number : 212-255-2333
Provider Enumeration Date : 08/26/2010
Last Update Date : 08/26/2010

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